460 Henderson 2012 from 10/21 - 12/31ReciphifitCommiftee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Statement covers period
from 10/21/12
through
12/31/12
1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4.
® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure
Q State Candidate Election Committee Committee
Q Recall Q Controlled
(Also Complete Part 5) O Sponsored
(Also Complete Part 6)
❑ General Purpose Committee
Q Sponsored ❑ Primarily Formed Candidate/
Q Small Contributor Committee Officeholder Committee
Q Political Party/Central Committee (Also Complete Part 7)
3. Committee Information LD. NUMBER
1349748
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
Terry Henderson for Mayor 2012
STREET ADDRESS (NO P.O. BOX)
54711 Eisenhower Dr.
CITY STATE ZIP CODE AREA CODE/PHONE
La Quinta CA 92253 760-564-3044
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY STATE ZIP CODE AREA CODE/PHONE
Date of election if app/
(Month, Day, Year)
RECEIVED COVERPAGE
2DJ3 SN Da Staff 1
11/6/12 1
CI Y1 0 LA Qlij1N A % of�—
Page
__L__
T Y CLERK'
S G i ) I C For Official Use Only
2. Type of Statement:
❑ Preelection Statement
® Semi-annual Statement
❑ Termination Statement
(Also file a Form 410 Termination)
❑ Amendment (Explain below)
❑ Quarterly Statement
❑ Special Odd -Year Report
❑ Supplemental Preelection
Statement - Attach Form 495
Treasurer(s)
NAME OF TREASURER
Richard L. Jandt
MAILING ADDRESS
54711 Eisenhower Dr.
CITY STATE ZIP CODE AREA CODE/PHONE
La Quinta CA 92253 760-564-3044
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS
Fax 760-564-3044 FAX 760-564-3044
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify
under penalty of perjury under the laws of the State of California that the foregoing is true and c rrect.
Executed on 13 By
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Executed on By
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Executed on
Date
By
Signature of Controlling Officeholder, Candidate, State Measure Proponent
Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/OS)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276.3772)
State of California